| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,245 |
2,229 |
$189K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
390 |
281 |
$186K |
| D4341 |
|
1,982 |
562 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,758 |
1,749 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
928 |
494 |
$108K |
| D4910 |
|
1,070 |
1,060 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,637 |
1,630 |
$76K |
| D9430 |
|
1,083 |
1,001 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,806 |
1,791 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,642 |
1,411 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
360 |
195 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,428 |
1,321 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
879 |
872 |
$11K |
| D2954 |
|
99 |
77 |
$10K |
| D4342 |
|
215 |
78 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
86 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
68 |
$7K |
| D0274 |
Bitewings - four radiographic images |
233 |
231 |
$5K |
| D1120 |
Prophylaxis - child |
82 |
82 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D2394 |
|
13 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$1K |